Robotic versus open partial nephrectomy: a systematic review and meta-analysis

Abstract

Objectives: To critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN).

Materials and methods: A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.

Results: Eight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference [WMD]: 40.89; 95% confidence interval [CI], 14.39-67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio [OR]: 0.53; 95%CI, 0.42-0.67; p<0.00001), shorter hospital stay (WMD: -2.78; 95%CI, -3.36 to -1.92; p<0.00001), less estimated blood loss(WMD: -106.83; 95%CI, -176.4 to -37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies.

Conclusions: RPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings.

Figure 1. Flowchart for records selection process of the meta-analysis.

Figure 2. Forest plots of surgical outcomes.

(a) overall complications; (b) postoperative complications divided into Clavien grade 1–2 and 3–4; (c) transfusions; (d) conversions to radical nephrectomy; (e) ischemia time; (f) estimated GFR change; (g) unclamping rate; (h) length of stay; (i) estimated blood loss; (j) operative time; (k) positive margins. The following studies are cited: Alemozaffar et al 2013 , Laydner et al 2013 , Lee et al 2011 , Lucas et al 2012 , Masson-Lecomte et al 2013 , Minervini et al 2013 , Simhan et al 2012 , Yu et al 2012 .

Figure 3. Reporting bias analysis.

Funnel plots of the studies included in this meta-analysis reporting overall complication rates (a) and postoperative complications with Clavien grade classifications (b). SE = standard error; OR = odds ratio.